| NPI | 1306269477 |
|---|---|
| Former Name | ELLEN DENISE WIBRAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04822) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC MPA.2046) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2021-04-13 |